Community Dental Service

The Community Dental Service offers high quality, preventative-focused dental care for patients who find it difficult to use general dental services.

The objective of our Service is to reduce inequalities in oral health and improve access to dental services to priority patient groups, vulnerable adults and children in the Isle of Man.

Community dentists work in a variety of locations, for example, a patient’s own home, nursing homes and within one of the two community dental clinics (Douglas and Ramsey).  The dentists work with a wider clinical team including other health professionals such as school nurses, health visitors and district nurses. 

The Community Dental Service provides the children’s dental GA (General Anaesthetic) list at Nobles hospital.  Children who are very anxious about dentistry are assessed in the community clinics and they can receive a full treatment plan which includes extractions, fillings and preventative treatment whilst under a general anaesthetic.  This is one of the only community dental services in the UK that provides comprehensive care in this way.

Our specialist skills and facilities enable us to see patients with complex needs who find it difficult to use general dental services such as:

• Wheelchair users who are unable to transfer from their wheelchairs to the dental chair; we have access to a DIACO wheelchair ramp. This allows the patient to have their treatment carried out while remaining in their chair. We also have a bariatric wheelchair for patients who exceed the weight limits for our dental chairs (greater than 135-159kg). More information can be found on page 11 of the InTouch article about DIACO.
  
  
• People who are genuinely house-bound living in their own home or residential care and unable to attend a dentist at a surgery, we can offer patient centred care in the patient’s own environment.

• For patients with a severe dental phobia we can offer treatments under conscious sedation (both inhalation and intravenous techniques) for children and adults. Inhalation sedation is available to all age groups and patients with complex medical histories, whilst IV sedation is normally only available to patients who are fit and well and over 16 years old.

  Inhalation sedation also known as 'happy air' is a mixture of oxygen and nitrous oxide gases which are breathed through a small nose piece during the dental treatment. Patients stay awake but are slightly sedated. It is useful during dental treatment as it helps nervous patients relax. They can often become giggly or have tingles in their fingers and toes and can find treatment becomes a pleasant experience making it a successful way of managing anxiety in both children and adults.

  Intravenous conscious sedation relaxes you and makes you feel less anxious. Unlike general anaesthesia, you are still conscious but are so sleepy and relaxed that you are indifferent to the dental treatment. Your memory of treatment may be hazy and you may remember little or nothing about the treatment you have had. It is intended that over time, as your confidence grows, the eventual outcome will be that you will be able to cope with routine treatment without sedation.

  During intravenous conscious sedation the medication is delivered by injection in the back of the hand or arm. Once you are sufficiently relaxed and feel happy to proceed, the dentist will numb up the appropriate part of the mouth before dental treatment starts.

  Advanced sedation techniques can be used with the assistance of Dr Mike Blayney, Consultant Anaesthetist.

  We also have specialist training in hypnosis and behavioural management techniques.

Service availablility

• Patients with complex medical / mental health conditions who need additional dental care.
• Patients with moderate / severe learning difficulties and / or behavioural problems / dental phobia who find it difficult to cope with routine dentistry.
• Patients with complex social needs / looked after children or those subject to child protection plans.
• Patients with physical difficulties resulting in mobility problems which make it difficult or impossible to access care through general dental services.

Access to this service

We only accept written referrals from a health care professional such as:

• Other dentists
• Doctors
• Other health professionals - health visitors, nurses, looked after children team, social workers
• Carers of patients – residential / nursing homes
• Community psychiatric team
• Voluntary organisations

A referral can be made to the service by completing the referral form above and sending it to;

All patients will be assessed on an individual basis and will fall into 1 of 3 categories:-

1. Not accepted - For those who do not meet the remit of the service.
2. Accepted for a course of treatment and then discharged back to the referrer, or signposted to continuing dental care
3. Accepted for continuing care if deemed appropriate by the dentist. 

Discharge Criteria from the Community Dental Service

The service will consider discharge planning as part of the initial assessment for all newly referred patients.

• Patients with complex medical conditions can be discharged following treatment providing their medical condition is stable.
• Patients with learning difficulties, physical difficulties or mental health problems can be discharged following treatment with the support of their carers. For some patients, a decision may be made for them to be seen at a future date by the Community Dental Service.
• All dental phobic patients can be discharged, but can be referred again if appropriate.
• Patients who can be treated by a general dentist with input from the special care team.
• Patients who are unsuitable to be cared for by a general dentist will remain under the care of the Community Dental Service.

For those who do not fall into the above categories and want to seek allocation to an NHS dentist, please visit www.gov.im/dentists